PARASOMNIA

By I Made Karma Setiyawan 1

Problem Identification
How is normal sleep physiology? What is parasomnia and the classification? What is parasomnia specifically?

Normal Sleep Physiology

Known as ciradian rhythm Comprise into : 1. NREM (Non Rapid Eye Movement) 2. REM (Rapid Eye Movement)

NREM
Stage 1 Drowsiness state Occur 3-5 minutes, easily awaken Low to medium-amplitude delta and theta activity intermixed with faster frequencies Stage 2 - Symmetrical theta wave with delta wave activity less than 20% - Constitutes 45% to 55% of total sleep time. -

NREM
Stage 3 - 20% to 50% of delta activity Stage 4 - Deep sleep and difficult to awaken - >50% of delta activity

REM
Rapid eye movement, very low muscle tone, if awaken almost whole organ can tell their dreams Low-voltage, mixed frequencies with admixed alpha activity that is usually 1 to 2 Hz slower than the waking alpha rhythm

Parasomnia Classification
According to ICSD classification :
1. 2. 3. 4. Sleep-Wake Transition Disorder Arousal Disorder REM Parasomnia Other Parasomnias

Sleep-Wake Transition Disorder

Rhytmic Movement Disorder - more common during sleep stage 1 and 2 - include head banging, body rocking movements, rocking on hands and knees - common in infant/toddler (1-2 years) and persist until preschool (3-5 years) - spontaneous resolution

Sleep-Wake Transition Disorder

Nocturnal Leg Cramp - painful sensation in the leg or foot during sleep, pain is relieved by forceful stretching - 6% nightly in adults over the age of 60 years Sleep Talking - verbal output during sleep - commonly during drowsiness and stage 2 - harmless and does not require

Sleep-Wake Transition Disorder

Sleep Start - sudden, brief contractions of muscles in the extremities or head - Reassurance - no known treatments

Arousal Disorder
Confusional Arousal
- react slowly to commands, difficulty understanding , problems with short-term memory - lasts from 5 to 15 minutes - Treatment is very seldom needed

Night Terror
-

sudden, terrified screaming associated with an intense autonomic component confusion upon awakening, without memory Management : scheduled awakenings,

Arousal Disorder
Sleepwalking - wandering around the house, sitting in bed, moving object around, eating, urinating in closets, or going outdoor - go back to bed themselves - Management : scheduled awakenings

REM Parasomnia
Nightmare - occur during the second half of the night to early morning - recollection of dream content - Management :parental reassurance, imagery rehearsal, desensitization

REM Parasomnia
REM Sleep Behaviour Disorder - act out their dream - such as punching, yelling, swearing, kicking, screaming, grabbing, talking, running, crawling, and jumping out of bed - Management : clonazepam

REM Parasomnia
Sleep Paralysis - conscious, unable perform any movement or action - feeling of pressure REM Sleep Sinus Arrest - prolonged asystole, up to 9 seconds - chest pain, palpitations, fatigue, lightheadedness, presyncope, or syncope

REM Parasomnia
Sleep-related Penile Tumescence should naturally occur initiated by parasymphatetic stimulation Impaired Sleep-related Penile Erection the incapability to maintain an adequate penile erection during REM sleep Management :overcoming the underlying factors

REM Parasomnia
Sleep-related Painful Erection - Middle-aged and elderly men ofter report these complaints

Other Parasomnia
Sleep Bruxism - toothgrinding sounds or tooth clenching during sleep - self-limiting - Management : dental appliances, pain relief, and stress management

Other Parasomnia
Sleep Enuresis - involuntary micturition during sleep with normal waking bladder control - Management : urine alarm Nocturnal Paroxysmal Dystonia - repeated episodes involving a single or all extremities or paroxysmal arousals - Short-lasting or long-lasting

Other Parasomnia
Sudden Unexplained Nocturnal Death Syndrome - ST-segment elevation in the right precordial leads (V1-V3) Infant Sleep Apnea - infants older than 37 weeks - pale or bluish color change, hypotonia, observed cessation of breathing during sleep, or associated noisy breathing during sleep

Other Parasomnia
Primary Snoring - simply loud airway breathing sounds - without indications of reduced airflow, or other signs of sleep apnea Benign Neonatal Sleep Myoclonus - occurs in the neonatal period, not persist beyond infancy - involving limbs and trunk

Other Parasomnia
- Spontaneous resolved, by 30 months of age - Management : no treatment